Bedwetting (or nocturnal enuresis) is an involuntary leakage of urine from the bladder during sleep, over which a child has no conscious control. Bedwetting is a common childhood problem that causes great distress to many families.
It affects millions of children worldwide, as well as some adults and elderly individuals. Bedwetting is typically not even considered abnormal or a problem in our modern-day society until after age 7. The rate at which both children and adults’ bed wet increases daily.
According to ancient history, children who usually bed wetted were forced by guardian to undergo several punishments. However, the most interesting story about children bedwetting is not a taboo. Although modern medicine and clinical sciences have proven that there is no exact cure for it and also there are some steps to take for controlling bedwetting.
Research on this topic has proved that a ratio of 2:1 between boys’ and girls’ bed wet. That means that twice the number of boys wet the bed than girls.
For the parents, guardian or caregiver, this process and time of your child’s life could be exhausting and frustrating. Night after night, soggy sheets and pyjamas are experiences one could wish it disappeared.
Some children that bed wet often experience low self-esteem and stigma while for some is a standard developmental stage.
About two percent of adults experiencing bedwetting is as a result of an underlying disease or illness and this may require immediate treatment.
How the body works?
As the body processes digestion, it removes toxic substances and waste products through the urinary system. The urinary system is in charge of making, storing and removing urine from the body.
When the kidney cleanses the blood, urine travels from the kidney to the bladder. The bladder is regarded as a holding container for urine. The bladder expands and fills up until it becomes full.
Once the body is ready to release urine, the brain sends a signal to the bladder. Then the bladder muscles contracts and pushes out the urine out of the bladder through the urethra.
Young infants release urine in an uncontrolled way by a simple reflex. In other words, children urinate when there is pressure on the bladder. But as they grow and mature, not only does their bladder grow with them, but they gain control over the pelvic floor muscles.
Causes of bedwetting
In as much as bedwetting is a natural phenomenon that every child goes through, we have to understand ‘what causes it?
- Abnormality, injury or disease of the nervous system causing neurological (brain) disorder.
- Fatigue: The body needs adequate rest. So, if a child doesn’t get enough rest it begins to behave abnormally.
- Medical conditions such as urinary tract infection, type 1 diabetes, etc.
- Genetic: Bed wetting (enuresis) can be inherited. Maybe one of your parents might have had same issue while growing up.
- Bladder capacity: Either your child has too many muscles that prevents the bladder from producing urine or he/she have a thin bladder which cannot hold a relatively high volume of urine. This occurs mostly in teens and some adults.
- When a child refuses to wake up when his/her bladder is full.
- When there is an excessive production of urine at night.
- Slow development of brain-bladder control.
- Constipation: The urinal and excretory system share the same muscles. Therefore, when stool is piled up, the rectum places pressure on the bladder which causes a leak.
- Caffeine: Regular intake of caffeine causes you to urinate frequently.
How can I deal with this?
If a particular sickness is causing you to bed wet, your doctor should give you a medication. The medication works in two ways which are it can either help the bladder hold more urine or it helps the kidneys make less urine.
Most children with bedwetting do not need to take medication, but there are some occasions when it can be useful. Your doctor can advise you if the treatment is suitable for your child. Such medication includes Minirin, Imipramine, Desmopressin, Anticholinergics. It should be noted that not all children respond to medication and these medicines may have side effects.
But if your doctor does not find any complications in the history and physical examination he has carried out, and the urine appears negative. Then several behavioral approaches can be used for treatments.
- Food and Fluid intake: Ensure to increase the fluid intake earlier in the day and reduce it later in the period before bedtime. However, try not to take drinks, or eliminate the ones containing caffeine, dairy products, carbonated drinks, citrus juices, and artificial flavoring late at night. Such includes chocolate milk, tea, coffee, cola, etc. Parents should control the amount of food intake given to their children at night. Dinner should be served earlier enough, possibly around 6pm to 7pm.
- Schedule bathroom breaks: Bed wetting normally occur during the first few hours of sleep. A good method of prevention is to ensure that your child makes use of the bedroom before bed. Also have a regular toilet routine schedule (every two to three hours) and right before bedtime. This also helps in bladder-training.
- Easy access to the bathroom: Make sure your child can easily reach the bathroom at night. For example, use a night light in the hall or in the bathroom.
- Be encouraging: Motivational therapy is very important to the child’s mental well-being. Make your child feel good about making progress. Preserve the child’s self-esteem as children who experience bed wetting often have low self-esteem and are embarrassed. Talking to your child with a positive language such as becoming “a big kid” when he/her doesn’t use a diaper anymore is very helpful.
- Be patient: Getting angry, punishing or making fun of your child for wetting the bed will only make the situation worse – make sure the other siblings understand this and works hand in hand with you. Be positive on the child’s good and bad nights. Be patient enough to watch your child make progress even if it’s slow.
- Practice wake up calls at night: Trying out wake up calls at night might be helpful. While this might be effective for some, for others it might not. Waking up a child at night for a wee would most likely interfere with his sleep and lead to sleeplessness.
- Deal with chronic constipation: Difficulties with constipation contribute to bladder problem especially at night. As constipation problems are resolved, there is less pressure on the bladder since the rectum is right behind the bladder.
- Keep a record of each night: It can be helpful to keep a record chart of wet and dry nights. Your child should make the chart themselves as it can be a fun activity. Charts are used to keep records of when accidents happen. This will help your clinician diagnose and treat urinary incontinence.
- Moisture alarm: The alarm consists of a moisture-sensing device attached to the pajamas that wakes the child with a loud sound or vibrating alarm when your child pee on the bed. However, bed-wetter’s do not always wake up because most are deep sleepers. You can write down your child’s response to the alarm and keep track of his or her progress.
Also, there are bedwetting alarms which doctors prescribed for children having bedwetting issues. So, it helps them wake up on time to avoid bedwetting. Children who are deep sleepers should be assisted by their parents and siblings to wake them up whenever the alarm comes up.
Conclusively, most children outgrown bedwetting. What parents should stick to, is being a support to their children. Bed wetting patients should promptly seek medical advice in order to rule out any complications.